EDITORIAL
published: 21 January 2022
Edited and reviewed by:
Clelia Madeddu,
University of Cagliari, Italy
*Correspondence:
Eric C. Westman
ewestman@duke.edu
Specialty section:
This article was submitted to
Clinical Nutrition,
a section of the journal
Frontiers in Nutrition
Received: 02 December 2021
Accepted: 28 December 2021
Published: 21 January 2022
Citation:
Westman EC (2022) Editorial:
Carbohydrate-Restricted Nutrition and
Diabetes Mellitus.
Front. Nutr. 8:827990.
doi: 10.3389/fnut.2021.827990
Frontiers in Nutrition | www.frontiersin.org
doi: 10.3389/fnut.2021.827990
Editorial: Carbohydrate-Restricted
Nutrition and Diabetes Mellitus
Eric C. Westman*
Department of Medicine, Duke University Medical Center, Duke University, Durham, NC, United States
Keywords: insulin resistance, type 2 diabetes, metabolic syndrome, ketogenic, low carbohydrate diet,
carbohydrate-restricted diet
Editorial on the Research Topic
Carbohydrate-Restricted Nutrition and Diabetes Mellitus
Insulin resistance is characterized by elevated insulin levels. The most commonly used approaches
to treat conditions caused by insulin resistance, including Type 2 Diabetes (T2DM), involves
medications. The management of insulin resistance with medications then typically leads to a need
for “intensification of medications” to improve glycemic control (1). However, giving medications
like insulin to treat insulin resistance and/or T2DM does not cure these conditions—it perpetuates
or even worsens the insulin resistance. This consequence is especially likely if medication treatment
leads to weight gain, because weight gain leads to a worsening of the insulin resistance. An
alternative approach to the treatment of insulin resistance is to use strategies that lower insulin
blood levels, including non-pharmacologic treatments.
Obesity Medicine is a medical subspecialty that treats T2DM by targeting underlying
contributors of insulin resistance and T2DM: obesity and lifestyle. One of the lifestyle approaches
used by obesity medicine specialists is a carbohydrate-restricted diet (2). Several studies have shown
that a carbohydrate-restricted diet can lead to improvements and even reversal of T2DM (3, 4).
Because many barriers exist to the implementation of carbohydrate-restricted diets into medical
practice, this Research Topic invited articles related to the use of carbohydrate-restriction for
T2DM. In this Research Topic, the paper topics range from theoretical to practical aspects of the
use of carbohydrate restriction to reverse insulin resistance and T2DM.
In the first article, Westman gives an often overlooked perspective on how relatively little glucose
resides in the human bloodstream at any given moment, and emphasizes the importance of dietary
carbohydrate as a major factor in addressing T2DM. Wheatley et al. review many of the studies
regarding carbohydrate restriction and the treatment of T2DM, with a focus also on some of the
common concerns that still exist.
Then, several clinical series are presented that demonstrate the efficacy of carbohydrate-
restricted diets in clinical settings. Wolver et al. estimate that 70–90% of patients were no longer
taking insulin after 1 year, depending on the level of adherence—AND had improved glycemic
control and weight loss. Gavidia and Kalayjian address the dogma that improvement in diabetes
is a result of weight loss, not diet change. They report three cases of a substantial reduction in
hemoglobin A1C without clinically meaningful weight loss.
Using carbohydrate-restricted diets can lower the blood glucose dramatically on the 1st day of
the dietary change, so the reduction of medication (“de-prescribing”) is often needed on the 1st day
of the dietary change. Cucuzzella et al. give advice on how to de-prescribe medications when using
a carbohydrate-restricted diet. Finally, Griauzde et al. address the challenges that exist in translating
the evidence-base of carbohydrate-restricted eating into clinical practice.
1 January 2022 | Volume 8 | Article 827990
Westman
Carbohydrate-restriction provide an attractive approach to
treat conditions caused by insulin resistance without the need for
medications. Carbohydrate-restriction reverses insulin resistance
by lowering the blood glucose and insulin levels, and by a loss of
fat mass. While no prevention studies are available yet, it is logical
to hypothesize that using carbohydrate-restriction may also be
useful for the prevention of overweight, prediabetes, metabolic
syndrome, and T2DM. It makes sense to now study the use of
REFERENCES
1. American Diabetes Association. Pharmacologic approaches to glycemic
treatment: standards of medical care in diabetes-2020. Diabetes Care. (2020)
43(Suppl.1):S98–110. doi: 10.2337/dc20-S009
2. Bays HE, McCarthy W, Burridge K, Tondt J, Karjoo S, Christensen
S, et al. Obesity Algorithm eBook, Presented by the Obesity Medicine
Association. www.obesityalgorithm.org. (2021). Available online at: https://
obesitymedicine.org/obesity-algorithm/ (accessed November 30, 2021).
3. Westman EC, Yancy WS Jr, Mavropoulos JC, Marquart M, McDuffie JR.
The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index
diet on glycemic control in type 2 diabetes mellitus. Nutr Metab. (2008)
5:36. doi: 10.1186/1743-7075-5-36
4. Athinarayanan SJ, Adams RN, Hallberg SJ, McKenzie AL, Bhanpuri NH,
Campbell WW, et al. Long-term effects of a novel continuous remote care
intervention including nutritional ketosis for the management of type 2
diabetes: a 2-year non-randomized clinical trial. Front Endocrinol. (2019)
10:348. doi: 10.3389/fendo.2019.00348
Frontiers in Nutrition | www.frontiersin.org
Editorial: Carbohydrate-Restricted Nutrition and Diabetes Mellitus
carbohydrate-restricted diets for disease prevention, especially
in children.
AUTHOR CONTRIBUTIONS
The author confirms being the sole contributor of this work and
has approved it for publication.
Conflict of Interest: EW receives royalties from the sale of books related to
low carbohydrate diets and is founder of a company based on the principles of
carbohdyrate-restriction.
Publisher’s Note: All claims expressed in this article are solely those of the authors
and do not necessarily represent those of their affiliated organizations, or those of
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Copyright © 2022 Westman. This is an open-access article distributed under the
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2 January 2022 | Volume 8 | Article 827990